Antidepressant counselling

Question 1

focussed depression hx

Answer 1

low mood, energy, enjoyment

poor sleep, appetite, concentration

RISK

explore previous tx & establish current understanding

Question 2

ATHLETICS of antidepressants

Answer 2

tablet

PO morning after breakfast

SSRIs increase serotonin (happy hormone) in brain

Question 3

stepwise approach to antidepressant therapy according to efficacy

Answer 3

SSRIs work within 6m in 60& of people (if 1st episode) - most within 3-4w

if no response –> different SSRI –> 80%

if no response –> venlafaxine (SNRI) or mitrazapine (NaSSA) or amitriptyline (MOA)

Question 4

duration of antidepressant

Answer 4

after feeling better

if 1st episode –> continue for 6 months

if 2nd episode –> 1-2 years

> =3 episodes –> 3-5 years

Question 5

SSRIs cessation

Answer 5

gradual

not addictive

Question 6

SEs

Answer 6

GI upset, insomnia, low libido, self-harm thoughts, seretonin syndrome (agitation, sweating, palpitations, fever)

Question 7

SSRI monitoring

Answer 7

2w follow up appt (1w if <25)

if high dose citalopram ECG for ++QT

Question 8

pregnancy advice

Answer 8

generally avoid

consider if benefits > risks

Question 9

brief biopsychosocial

Answer 9

bio - meds

psycho - IAPT, CBT

social - alcohol, exercise, job

Question 10

serotonin syndrome warning

Answer 10

find out things that increase serotonin when co-prescribed along SSRIs